Hypothermia: Our treatment is our prevention
This has been one of the warmest winters on record. Yet, hypothermia continues to be a threat to our patients, especially our trauma patients.
Even in the sunshine state of Florida, hypothermia is a threat to those exposed to the elements. Trauma patients are exceptionally vulnerable to hypothermia. Patients experiencing shock, burns, and head and spinal injuries are most susceptible.
We know that hypothermic patients are never considered dead until they are warm and dead. Due to the mammalian reflex, our body shunts the blood from our periphery to our core body organs, perfusing them in order to maintain life.
It also slows perfusion to conserve and preserve our vital organs. Therefore, when the body begins to warm, the patient’s body begins to restore perfusion to areas where blood was shunted away.
In a traumatic patient, perfusion is compromised in a patient presenting with shock. In burn patients, we need to be concerned with fluid loss among other problems, and in spinal and head injuries, the regulation system of our body has been compromised.
In cardiac arrest patients (non-traumatic) with return of spontaneous circulation (ROSC), induced hypothermia is considered the standard of care.
However, in contrast, in patients with traumatic brain injuries, there are no significant differences in outcome with induced hypothermic treatment.
This trial (Daniel Limmer, Michael O’Keefe, 2009, Emergency Care) is thought to draw a final conclusion to a now nearly decade-long investigation as to whether hypothermia improves TBI outcomes.
We remain in need of effective TBI therapies, but researchers will have to look elsewhere as temperature control is clearly not the answer. Therefore, we know hypothermia is not the friend of a patient with a traumatic injury.
The best method to any problem is preventing it from happening in the first place. Our treatment in this situation mirrors our prevention practice.
However, the sooner we recognize the potential for the trauma patient to suffer from hypothermia, the better we can prevent the trauma patient from becoming more hypothermic.
In order to prevent the loss of body temperature, we need to know how we lose heat. We know that our body regulates our temperature; however, it is susceptible to lose heat through conduction, convection, radiation, evaporation, and respiration.
You can prevent the patient from becoming hypothermic by putting a warm item, such as a warm blanket, between the patient and the surface, or remove the patient from the cold surface altogether.
Providing oxygen will not only provide the patient with the much-needed oxygenation, but also help prevent hypothermia from their respiration.
Our treatment for hypothermia is also our prevention for our trauma patient. It does not matter where you are in the country; if the environment is cooler than our body temperature, hypothermia is possible.
There are five ways our body loses heat. As part of our treatment for these patients, we should immediately take into consideration the prevention of hypothermia for our trauma patients. Tunnel visioning can be detrimental to the prevention of hypothermia in a trauma patient. Treating hypothermia in a trauma patient is the prevention of further hypothermia.
S. Andrew Josephson, MD, Hypothermia Ineffective in Traumatic Brain Injury Posted: 01/27/2011; AccessMedicine from McGraw-Hill © 2011 The McGraw-Hill Companies retrieved from http://www.medscape.com/viewarticle/735959 on March 18, 2012
Daniel Limmer, Michael O’Keefe (2009) Emergency Care, 11th Edition Upper Saddle River, NJ
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